Active NPI
Shelley D Seabolt, NP
- Nurse Practitioner
- Fort Wayne, IN
National Provider Identifier
1508330796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 28197368A
- Practice address
- 2121 Lake Ave
Fort Wayne, IN 46805-5100 - Phone
- (260) 426-5431
- NPI assigned
- Jan 22, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 28197368A | IN | Primary |
Addresses
Primary practice location
2121 Lake Ave
Fort Wayne, IN 46805-5100
Mailing address
7910 W Jefferson Blvd Ste 108
Fort Wayne, IN 46804-4159
Phone (260) 484-8830
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28197368A | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695600000000",
"number": "1508330796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7910 W JEFFERSON BLVD STE 108",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044159",
"telephone_number": "260-484-8830",
"fax_number": "260-483-1911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 LAKE AVE",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055100",
"telephone_number": "260-426-5431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEABOLT",
"first_name": "SHELLEY",
"middle_name": "D",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-22",
"last_updated": "2023-09-25",
"certification_date": "2023-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "28197368A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.